Nurseweek: A New Partnership: Civil unions allow gay, lesbian couples more say in each other’s care

A new partnership
Civil unions allow gay, lesbian couples
more say in each other’s care

By Diane Sussman
July 10, 2000

A bill that creates a marriagelike civil union for gay and lesbian couples will take effect this month in Vermont. More than 30 states ban same-sex marriages.

Photo: Photodisc/
Pavel Zoudilov


	You've read the article. Now tell us what you think. Related sites Partnership for Caring Inc. Gay and Lesbian Medical Association Vermont State Nurses Association

Febrile, frightened and short of breath after a bout with bronchitis, Gaynelle Johnson urged her partner to call her doctor. But the doctor rebuffed the woman, Johnson recalled, saying he could speak only to a blood relative.

That was 10 years ago, and the Sacramento, Calif., marriage and family counselor admits she had nothing – no medical power of attorney, no living will, no domestic partner registration – documenting the relationship. Nevertheless, she says, "It absolutely floored me. I wanted her to make the decisions, but he said no. I had no idea they would not respect my wishes."

Stumbling blocks
Beginning this month, situations like Johnson’s will become part of the past in Vermont, as a bill creating a marriagelike "civil union" for same-sex couples goes into effect. The bill, the first in the nation, creates an institution for gay and lesbian couples that almost parallels traditional marriages, but without the name. The 300 or so benefits that couples will receive include inheritance rights, tax breaks and the power to make medical decisions for a partner.

Elsewhere in the United States, however, health care workers still will find themselves faced with decisions that, in many cases, pit their emotions against the law. At present, more than 30 states ban same-sex marriages and, in 1996, Congress passed the Defense of Marriage Act, which allows states to refuse to recognize same-sex marriages certified in other states.

California strengthened legal barriers to same-sex unions in March when it passed Proposition 22, which stipulates that "only marriage between a man and a woman is valid or recognized in the state."

Besides creating ethical quandaries for nurses, such laws can hamper health care, said certified rehabilitation registered nurse Faith Brothers, MS, RN, executive director of the Vermont State Nurses Association.

"It’s difficult, especially in ICU, when you have a significant other who is shut out of the process and a family member who is not all that connected making the decisions," she said. "It really is a hindrance in nursing and caring for people, and in getting them what they need as a patient. It’s heart-wrenching."

Kate O’Hanlan, MD, a gynecologic oncologist at Stanford Medical Center and past president of the Gay and Lesbian Medical Association, agreed. "I don’t think most doctors and nurses want to get in the way of the family we’ve chosen, but sometimes the law has that effect. I think most doctors and nurses don’t want legal barriers getting in the way of their compassion."

Even before same-sex civil unions were proposed in the Vermont Legislature, the state nurses association pressed the issue in its legislative platform, declaring health care a "human right" that should be available to "all people regardless of race, creed, color, gender, age, physical disability, lifestyle or sexual orientation." "It’s pretty simple," Brothers said. "We support those things that enhance people’s access to care. When you look at our constitution – and I looked – it clearly supports that."

Papers, please
Outside of Vermont – and this applies to Vermont couples traveling in other states – advance directives are the best way to make one’s wishes known. "We really encourage people to get their paperwork done – before they get sick," said Linda McGehee, Ph.D., RN, an assistant professor of nursing in the School of Nursing at Georgia State University in Atlanta, who runs a cancer support group for lesbians.

Advance directives can be used in every state and are backed either by legislation or court precedents. The 1991 Patient Self-Determination Act requires hospitals and nursing homes to inform patients that they have the right to fill out advance directives, even though many defer.

Same-sex couples need the same paperwork as any other couple, said Karen Orloff Kaplan, MPH, president and chief executive officer of the Washington-based Partnership for Caring Inc., a successor to the group that created the first living will.

"The first [document]," she said, "is a living will, which stipulates what kind of care you would like – or not like – if you can’t speak for yourself. The second is a medical power of attorney, or health care proxy. That is the document in which you appoint a representative – your lobbyist if you will – to be your spokesperson."

Ultimately, however, advance directives are only as strong as the understandings on which they were built "The other half of the job is to talk about it with your partner, your family and your health care provider. You have to make sure people understand and agree. If you do it alone, it’s just a piece of paper," Kaplan said.

Despite absent paperwork and legal barriers, "there are good stories, too," McGehee said. "I heard of one woman who was dying of breast cancer and the hospital intervened to let her partner in. And it happened because of the efforts of the nurses and chaplain. And it was a Catholic-based hospital here in the South. I was really proud of that hospital."